1548329188 NPI number — MR. PATRICK WILLIAM STORER PT

Table of content: MR. PATRICK WILLIAM STORER PT (NPI 1548329188)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548329188 NPI number — MR. PATRICK WILLIAM STORER PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STORER
Provider First Name:
PATRICK
Provider Middle Name:
WILLIAM
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
PT
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1548329188
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/26/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 MEDICAL PARK
Provider Second Line Business Mailing Address:
BUSINESS OFFICE NTTC
Provider Business Mailing Address City Name:
WHEELING
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
26003-6379
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-243-3124
Provider Business Mailing Address Fax Number:
304-243-1131

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3000 GUERNSEY STREET
Provider Second Line Business Practice Location Address:
BELLAIRE COMMUNITY HEALTH CENTER
Provider Business Practice Location Address City Name:
BELLAIRE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43906-1540
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-472-1656
Provider Business Practice Location Address Fax Number:
740-472-2250
Provider Enumeration Date:
12/08/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  PT06496 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)